Healthcare Essential Services Concerns/Violations (Strike)

Your name (required)

Your email (personal emails only)(required)

Your phone(required)

Where do you work?(required)

Job Title / Department(required)

Supervisor / Charge Nurse / Manager

Is your concern about scheduling?
YesNo
Is your concern about duties?
YesNo

Is your concern about agency staffing or non-CUPE staffing?
YesNo

Explain in detail what your concern is:

Are other CUPE members affected by your concerns?
YesNo

If you set yes to the above question, please provide further details:

Names and phone numbers of other CUPE members who are affected:

Did you raise your concerns with your supervisor?
YesNo

If yes, to whom?

How did they respond?

Do you want CUPE to forward this Essential Services concern to your supervisor?
YesNo

Supervisor / Charge Nurse / Manager email: